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IGF-1 at 3 months: The American Association of Clinical Endocrinology (AACE) growth hormone guidelines specify that any unexplained IGF-1 elevation above the age-adjusted upper limit of normal in a patient using a GH-axis compound requires immediate discontinuation and clinical review [11]

These generally show continued safety, but definitive long-term studies don't exist

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The convenience of a fixed blend is also its limitation

But after gastric bypass, making less intrinsic factor means less B12 gets absorbed